Changing policies and their influence on government health workers in Tanzania 1967-2009: Perspectives from rural Mbulu District

Tanzania has experienced fundamental policy shifts during the last fifty years. This included experimentation with reforms based on socialism and neoliberalism, and involved powerful actors. Public health services have been one of the main targets for policy and structural reforms, and personnel at the local level have had to cope with new measures under changing regimes. This article explores the public health services in Tanzania mainland from 1967 to 2009 from a health worker perspective. How did shifting policies influence government health workers in their daily work, and how did they perceive and respond to the policies? Oral narratives were collected mainly in rural Mbulu District, north central Tanzania. We argue that top-down experiments undertaken by development experts and politicians on the national and global arena during the socialist period (1967-1985) and the neoliberalist period (1986 to the present) had both intended and unintended outcomes. The experiences of the government health workers in this study provide a historical background to understand some of the present challenges in the public health sector in Tanzania.